Abstract
OBJECTIVE: To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery. METHODS: The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome. RESULTS: The strongest determinants of outcome include pre-operative pain/function-those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome-patients with RA did better than those with OA; deprivation-those living in poorer areas had worse outcomes; and anxiety/depression-worse pre-operative anxiety/depression led to worse pain. Differences were observed between predictors of pain and functional outcomes. Diagnosis of RA and anxiety/depression were associated with pain, whereas age and gender were specifically associated with function. BMI was not a clinically important predictor of outcome. CONCLUSION: This study identified clinically important predictors of attained pain/function post-TKR. Predictors of pain were not necessarily the same as functional outcomes, which may be important in the context of a patient's expectations of surgery. Other predictive factors need to be identified to improve our ability to recognize patients at risk of poor TKR outcomes.
Original language | English |
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Pages (from-to) | 1804-1813 |
Number of pages | 10 |
Journal | Rheumatology |
Volume | 51 |
Issue number | 10 |
DOIs | |
Publication status | Published - Oct 2012 |
Keywords
- Activities of Daily Living
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Arthritis, Rheumatoid
- Arthroplasty, Replacement, Knee
- Female
- Humans
- Knee Joint
- Male
- Middle Aged
- Osteoarthritis, Knee
- Pain
- Patient Satisfaction
- Postoperative Period
- Predictive Value of Tests
- Prognosis
- Prospective Studies
- Quality of Life
- Treatment Outcome